title: 'Do not attempt resuscitation'--do standardised order forms make a clinical difference above hand-written note entries?
abstract: OBJECTIVE
  To quantify any effect of Standardised Order Forms (SOFs), versus hand-written note entries for 'Do Not Attempt Resuscitation'--on the selection and survival of remaining cardiopulmonary resuscitation (CPR) attempts.
  
  
  METHODS
  A prospective, observational study in two UK Hospitals, comparing numbers, demographics and survival rates from CPR attempts for 2 years prior to and 2 years after the introduction of SOFs (the only change in DNAR policy).
  
  
  RESULTS
  There were 133 CPR attempts, representing 0.30% of the 44,792 admissions, pre SOFs and 147 CPR attempts representing 0.32% of the 45,340 admissions following the SOFs (p=0.46). The median duration of a CPR attempt was 11min prior to and 15min following the SOFs (p=0.02). Of the CPR attempts, there was no change in mean age (p=0.34), proportions occurring outside working hours (p=0.70) or proportions presenting with an initial shockable rhythm (p=0.30). Survival to discharge following CPR was unchanged (p=0.23).
  
  
  CONCLUSIONS
  The introduction of SOFs for DNAR orders was associated with a significantly longer duration of CPR (on average by 3-4min) but no difference in overall number, demographics or type of arrest or survival in the remaining CPR attempts.
authors.affiliation: Prince Philip Hospital, Hywel Dda NHS Trust, Wales, SA14 8QF, UK. k.e.lewis@swansea.ac.uk
authors.forename: Keir Edward
authors.initials: KE
authors.lastname: Lewis
authors.forename: Victoria Middleton
authors.initials: VM
authors.lastname: Edwards
authors.forename: Sian
authors.initials: S
authors.lastname: Hall
authors.forename: Paul
authors.initials: P
authors.lastname: Temblett
authors.forename: Hayley
authors.initials: H
authors.lastname: Hutchings
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000401:mortality*; D003710:Demography; D004282:Documentation / Q000379:methods*; D005568:Forms and Records Control; D006236:Handwriting; D006801:Humans; D008499:Medical Records; D008875:Middle Aged; D010351:Patient Discharge; D011446:Prospective Studies; D016414:Resuscitation Orders; D016019:Survival Analysis; D055815:Young Adult